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S560 ESTRO 35 2016

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ductal carcinoma in 2013. The idea is to develop a short

course C-ion RT to be finished in one week, which, we

believe, could replace surgery and more than 5 weeks of

radiotherapy. The purpose of this report is to evaluate

preliminary treatment results.

Material and Methods:

There are 2 treatment studies. One is

phase I/II clinical trial and the other is “general treatment

protocol” (GP). In clinical trial, candidates are patients with

low-risk stage I breast cancer who are suitable for APBI in

ASTRO consensus statement. A dose escalation study was

designed as a phase I clinical trial. Total dose is 48.0 GyE,

52.8 GyE and 60.0 GyE in 4 fractions within 1 week. In phase

I, patients planned to undergo surgery for pathological

evaluation 90 days after C-ion RT and then received

endocrine therapy. In phase II, patients had C-ion RT at

recommended dose and then received endocrine therapy.

Three-field C-ion beams with 290 MeV/n energy are used by

means of passive broad beam methods using individual

collimators and a compensation bolus absorber. Irradiation is

performed using respiratory gating. The other study, GP is for

the patients desiring to receive C-ion RT but ineligible to

enroll in the clinical trial due to minor variance or refusal to

enroll in the clinical trial. The first 2 patients of this GP were

treated by 52.8 GyE and the others by 60 GyE. All patients

were suitable for endocrine therapy after RT.

Results:

From April 2013 to October 2015, 18 patients were

treated. There were 3 cases of 48 GyE and 52.8 GyE and 1

case of 60 GyE of phase I, and 2 cases of 52.8 GyE and 9 cases

of 60 GyE of GP. Median age was 66 (44 ~ 81). Median tumor

size was 12 mm (4 ~ 20 mm). Median f/u period was 12 mos.

No normal tissue adverse events were observed except for

grade 1 skin reaction of CTC-AE v4 in 9 cases. At the time of

analysis, 7 patients underwent surgery and 2 of them reached

pCR. Of the GP patients, 6 reached CR, 4 reached PR and 1

developed PD on MRI. It took 3 months to 2 years with a

median of 6 months to reach CR on MRI. So the pathological

evaluation in phase I trial after 3 months must be too early

for evaluation. The PD patient with basal subtype tumor was

successfully salvaged by mastectomy.

Conclusion:

C-ion RT for primary tumor of breast needed

long time to reach CR on MRI. Low grade stage I breast

cancer has a potential to cure by accelerated partial breast

irradiation with C-ion RT.

EP-1176

Abstract withdrawn

EP-1177

Hypofractionated radiotherapy with concomitant boost for

breast cancer: a dose escalation study

C. Rinaldi

1

Campus Biomedico University, Radiotherapy, Roma, Italy

1

, E. Ippolito

1

, M. Fiore

1

, P. Matteucci

1

, A. Di

Donato

1

, P. Trecca

1

, S. Ramella

1

, R. D'Angelillo

1

, L. Trodella

1

Purpose or Objective:

to test the maximum tolerated dose

(MTD) of a concomitant boost to the tumor bed for patients

at high risk of recurrence treated with whole breast

radiotherapy (RT). The secondary endpoints are to evaluate

the acute and late toxicity and the cosmetic result recorded

by appropriate scales.

Material and Methods:

between June and August 2014 we

selected 9 patients with histologically proven breast cancer

with pathological stage pT1-2 and at least one of the

following risk factors for local recurrence: N1 disease,

lymphovascular invasion, extensive intraductal component,

close margins, non hormone sensitive disease, grading G3. All

patients were treated with hypofractionated RT to whole

breast to a dose of 40.05 Gy in 15 fractions. The dose

escalation to the tumor bed was delivered through a daily

concomitant boost technique at 3 levels of dose: 48 Gy (3.2

Gy/die), 50.25 Gy(3.35 Gy/die) and 52.5 Gy (3.5 Gy/die) for

the first, second and third level, respectively. We included 3

patients for each step (3 additional patients if a dose limiting

toxicity (DLT) Grade ≥ 2 oc curred); dose escalation to a

higher step was allowed if all patients of the lower one had

completed the treatment without DLT. MTD was defined as

the dose level below the dose induced DLT in at least 3

patients treated at a given dose level. A clinical evaluation of

the patients was carried out before treatment, 2 times a

week during RT, at the end of the same, at 3, 6 and 12

months after the end of RT. In addition to skin toxicity a

cosmetic evaluation was performed by radiation oncologist,

an in-training physician and by the patient herself. The latter

also filled the EORTC QLQ - C30 / BR23 on quality of life at

each evaluation.

Results:

we enrolled a total of 9 patients (3 for each dose

level) with a median age of 62 years (range 44-83). Patients’

characteristics are reported in Table 1. No dose limiting

toxicity Grade ≥ 2 occurred. The maximum toxicity collected

during RT was G2 skin toxicity in 7 (77%) patients (2 patients

with brisk erythema and 5 with moist desquamation). This

toxicity resolved at the first follow up. At a median follow up

of 11 months we recorded G2 induration/fibrosis in 3 (33,3%)

patients, one for each level of dose. There was a worsening

in the self perception of cosmetic outcome at the end of

treatment in 6 cases (66%) even if with no statistical

significance. Moreover, patients at the end of treatment,

reported a worse (not statistically significant) cosmetic

outcome compared to that expressed by the in-training

physician and the radiation oncologist. The evaluation of QoL

found an improvement of the score at the end of treatment

compared to initial in 7 of 9 patients (77%), above all in

elderly patients (≥ 62 years).

Conclusion

The 3-week course of postoperative RT with dose escalation

to the tumor bed to 52,5 Gy has been achieved without dose

limiting toxicities. Long-term follow-up data are needed to

assess late toxicity and clinical outcomes.

EP-1178

Predictive factors of patient compliance for breath-holding

during radiotherapy for breast cancer

R. Walshaw

1

Royal Preston Hospital, Rosemere Cancer Centre, Preston,

United Kingdom

1

, C. Robinson

1

, S. Yousif

1

, E. Young

1

, M. Hogg

1

, S.

Susnerwala

1

, A. Hindley

1

, C. Lim

1

, F. Danwata

1

, D.

Williamson

1

Purpose or Objective:

Radiation to the heart during

radiotherapy (RT) for breast cancer may lead to increased

risk of ischaemic heart disease years afterwards. A proposed

method of reducing cardiac dose is with breath-holding

techniques. Patients undergoing adjuvant breast RT form a

heterogenous group in terms of demographics and co-

morbidities. We aimed to determine what proportion of

patients from an unselected group eligible for adjuvant RT

would be able to comply with a simple breath-holding

technique pre-treatment, and whether any individual

characteristics may help predict success or failure.